Government

Article Abstract:

Recent changes in Medicare policy and costs are discussed and evaluated. In 1980, Medicare expenditures made up 3 percent of federal expenses, but by 1990 that figure is expected to grow to 9 percent. Consequently, Medicare is a favorite target for spending reduction and reform. In 1989, a new physician payment method was adopted, the first major change in Medicare since it began in 1965. This approach includes a Resource-Based Relative Value Scale, which represents an attempt to satisfy both policy and budgetary concerns. Unequal charges for the same services in different regions, and unequal charges among different medical specialties promoted these changes. The new system will be phased in over a four-year period, beginning in 1992. Payments for primary care will increase by 20 percent, and surgical payments will be reduced by 11 percent. Volume performance standards will establish caps on payment increases, with the possibility of Congressional intervention if services become too costly. Additional legislation in 1989 prohibited Medicare payments to laboratories owned by referring physicians, a situation found to exist for 12 percent of physicians. One study demonstrated that such relationships led to a 45 percent increase in the number of laboratory tests ordered. The Medicare Catastrophic Coverage Act would have covered several kinds of care now omitted, such as comprehensive hospital benefits and prescription drugs, but public opposition led to its repeal, except as it applies to the poor. Medicare pays for health care of older Americans, but public awareness of the more than 30 million people without medical insurance is growing. Medicaid assistance is now provided to low-income pregnant women and children. Medicare is at the center of federal health spending concerns, but the needs of the uninsured and the elderly for long-term care will affect future policy. Health care spending is constrained by overall budget considerations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Reports, Long-term care of the sick, Long term care, Medical law, Relative value scale payment systems (Medical care)

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Government

Article Abstract:

Both social and technological changes have made it impossible to separate the practice of medicine from government policy. The cost of Medicare programs is growing at about 12 percent per year, more than Social Security or defense programs. In 1990, nearly 9 percent of the federal budget went to Medicare. Congress is trying to grapple with the enormous and growing costs of medical care; one method has been to increase the deductible on Medicare, which increases the out-of-pocket costs for recipients. The changes are not limited to the Medicare program. At the same time that Congress is attempting to cope with the increasing cost of medicine in general, it must also deal with the special problems posed by the AIDS epidemic. For the first time, a federal law has been enacted to help states and municipalities to pay for the cost of caring for AIDS patients. A total of $226 million has been allocated for the 1991 fiscal year. In addition to helping health care providers in the 16 cities with the largest AIDS caseloads, the money will also help finance the development of comprehensive screening and counseling services. The Pepper Commission, mandated by Congress, has called for broad initiatives for improving health care and medical insurance coverage in the US. While the recommendations of the Commission provide a blueprint for future reform, many financial, logistic, ethical, and social problems remain to be solved before these goals are accomplished. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicaid

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Whatever happened to the health insurance crisis in the United States? Voices from a national survey

Article Abstract:

About 34 million Americans could be experiencing severe health problems because they can not get the medical treatments they need or can not pay for them. Researchers conducted telephone interviews with 3,993 Americans and asked them if they had recently been unable to get medical care or could not pay for it. Thirty-one percent reported being uninsured, unable to get medical care or unable to pay for care. Uninsured participants were more likely to have these problems, but 58% of those unable to pay their bills were insured. Up to 28 million insured Americans may be unable to afford adequate health care.

Medical care

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